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Organizational Membership Online Application Form

Name of the Organisation*

Address

Office

Address *

City *

District *

State *

Mobile *

Email *

Representative

a.Name *

Designation *

Mobile No *

Email *

b.Name *

Designation *

Mobile No *

Email *

Communicate to *

OfficeResidence

Corporate Membership

 Lumpsum Amount : 5,00,000/-

Organisation Membership

A.Domestic :
a1.Commercial Organisation Annual (Entrance Fees Rs.5,000/- + Membership Fees Rs.10,000/-): Rs. 15,000/-
a2.Commercial Organisation Life (Entrance Fees Rs.5,000/- + Membership Fees Rs.95,000/-): Rs. 1,00,000/-
a3.Educational Institution / Research Laboratories (Entrance Fees Rs.5,000/- + Membership Fees Rs.40,000/-): Rs. 45,000/-
B.Overseas:
Life Time Subscription Lumpsum Amount US $ 3,000/-
Please add GST @ 18%

The membership fee is to be added to the corpus fund.

Payment Details*

CashChequeD.D
Amount D.D / Cheque No Date drawn On (cheque/ D.D to be drawn in favour of "Indian Concrete Institute" payable at chennai. OR credit to the Account of ICI, A/C No. 000101208599 in ICICI Bank, Chennai Branch, NEFT/IFSC Code: ICIC0000001)

Endorsement of ICI Members

a.


b.


Organisation's Interest in Concrete(Indicate Order of preference a to I) *

a.Manufacturingb.Constructionc.Educationd.Researchf.Construction Machinesg.Consultancyh.Special Servicesi.Infrastructurej.Construction Chemicalsk.Laboratoriesi.Others (Please Specify)

Nature of Business *

Area of Specialization*

Contributions to concrete Tech. & Construction*

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